Exploring the Impact of Screening and Stewardship on Pediatric Antimicrobial Resistance

From 2011 to 2024, tertiary pediatric hospital surveillance shows that expanded screening detected substantially more colonization without an increase in MDRO-attributable hospital-acquired infections (HAIs).

Over this period, screening intensity rose roughly four-fold while hospital infection rates remained stable, an operationally important distinction for infection prevention teams making cohorting and case-finding decisions.

Detected colonization increased from 2.5 to a peak of 8.05 per 1,000 patient-days while MDRO-attributable HAI rates stayed around 0.27–0.62 per 1,000 patient-days. This pattern is consistent with higher screening intensity uncovering more colonization rather than a true rise in clinical MDRO disease; cohorting and isolation decisions should therefore be calibrated to screening intensity and colonization prevalence rather than assumed increases in MDRO-attributable HAIs.

There was an antibiotic-class redistribution: carbapenems, fluoroquinolones, and amoxicillin–clavulanate use declined, while cephalosporins, piperacillin/tazobactam, and glycopeptides increased. Overall antimicrobial consumption remained broadly stable (~278–356 DDD/1,000 patient-days).

Alcohol-based hand rub (ABHR) consumption more than doubled, peaking during the COVID-19 period and then partially normalizing to levels still greater than twice baseline—evidence of strengthened infection-prevention practice. The dataset did not show a measurable reduction in MDRO-attributable HAIs attributable solely to higher ABHR consumption; instead, hand-hygiene metrics function as a durable marker of IPC culture and readiness and should be sustained alongside surveillance and stewardship within multimodal bundles.

Key Takeaways:

• Expanded screening increases colonisation detection but does not necessarily signal rising MDRO-attributable HAIs.
• Antimicrobial stewardship can reshape antibiotic-class use without reducing total consumption immediately—monitor class-specific metrics.
• Rising hand-hygiene consumption is a durable marker of IPC readiness and should be sustained within bundled strategies.